“The Graham-Cassidy bill would significantly reduce funding to states over the long term, particularly for states that have already expanded Medicaid,” said Caroline Pearson, senior vice president at Avalere, in a post on the findings. “States would have broad flexibility to shape their markets but would have less funding to subsidise coverage for low- and middle-income individuals.”

The biggest winner would be Texas, which would see an additional $US35 billion in funds through 2026, according to the analysis. The biggest loser would be California, which would see a decrease of $US78 billion over the same timeframe.

All but two states that stand to gain funding under the plan voted for President Donald Trump in 2016.

Overall, Avalere found, federal funding to states for healthcare would decrease by $US215 billion through 2026.

The legislation would do away with the block grants after 2026, meaning a significant source of funding would be suddenly cut off.

Avalere also examined the potential decline in funding through 2036 if the grants expire and are not renewed. In this case, federal funding toward healthcare would decrease by roughly $US4.2 trillion dollars. Every state would see a decrease in funding against the current baseline, with a $US4 billion cut for Wyoming and South Dakota being the smallest.